Our 11 year old daughter, diagnosed with type 1 diabetes about five months ago, is on Lantus with Humalog before meals, and her morning readings are consistently 300-400 mg/dl [16.7-22.2mmol/L] even though we try to put her to bed with a blood sugar under 200 mg/dl [11.1 mmol/L]. With corrective Humalog we can get her under 200 mg/dl [11.1 mmol/L] for the rest of the day. We are working with her diabetes educators, but everyone is hitting a brick wall. They've mentioned hormones, growth, etc. Any suggestions?

Answer:

This is very interesting. I presume that she was placed on Lantus (insulin glargine) and Humalog from the very beginning. It seems unusual to have this degree of poor control six months into the diagnosis. Did she ever experience the honeymoon? Before I give a couple of general recommendations, I'd ask the following:

Be sure that you carb count well. You did not indicate her insulin-to-carb ratio, but I presume it is about 1 to 10 or 1-15 for meals and snacks. It doesn't take many extra carbs to mess up.

Are you comfortable that her meter is calibrated appropriately and therefore giving "true" values? This would be even more important if her A1c suggests excellent control by being less than 8%.

How much does she weigh? I find that the dose of Lantus approximates about 60% (sometimes a bit more, sometimes a bit less) of the total daily insulin dose. For an 11year old (pubertal) girl, I'd estimate a total daily dose of insulin (total of all insulins!) near 1 unit for every kilogram of body weight (essentially 1unit for every 2.2 pounds of body weight). Pubertal growth and pubertal hormones do play a role. Sometimes teens in puberty require near 1.5 units of insulin total throughout the day for every kilogram body weight.

Last Updated: Tuesday April 06, 2010 15:09:34
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